Do baseline resilience profiles moderate the effects of a resilience-enhancing intervention for adolescents with type I diabetes?

Abstract

Objective: Resilience processes include modifiable individual and family-based skills and behaviors and are associated with better health and emotional outcomes for youth with Type I diabetes (T1D). There is likely heterogeneity among adolescents with T1D based on differing profiles of resilience processes. At-risk adolescents with lower levels of modifiable skills and assets may benefit more from psychosocial skill-building interventions, compared to adolescents who already have strong resilience processes. This article identified whether there are subgroups of adolescents with T1D based on resilience process profiles and assessed differences in glycemic control, diabetes management behaviors, and distress at baseline. It also evaluated subgroups as moderators of the efficacy of a psychosocial skill-building program.

Method: Two hundred sixty-four adolescents with T1D (14 to 18 years) were randomly assigned to a resilience-promoting program (N = 133) or diabetes education control (N = 131). Data were collected at seven time points over 3 years and analyzed with latent profile analysis and latent growth curve modeling.

Results: There were two subgroups with high- versus low-resilience processes. The low-resilience subgroup exhibited more distress, higher HbA1c, less glucose monitoring, and fewer diabetes management behaviors at baseline. Differences persisted over 3 years. Subgroup membership did not moderate the efficacy of a resilience-promoting program compared to control. The resilience program resulted in lower distress regardless of subgroup.

Conclusions: There is heterogeneity in resilience process profiles, which are associated with clinically meaningful differences in distress, diabetes management, and glycemic control. Findings can be used to identify at-risk teenagers and inform a targeted approach to care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT01490619.

Figures

Figure 1

Main Effects of Intervention Group and Resilience Subgroup Membership on Change in Diabetes Distress

Figure 2. Effects of Intervention Group on Change in HbA1c for Low and High Resilience Subgroups

Note. Simple slopes from 0 to 16 months for the low resilience subgroup were modeled at one standard deviation above the mean of likelihood of classification in the low resilience subgroup. Simple slopes from 0 to 16 months for the high resilience subgroup were modeled at one standard deviation below the mean of likelihood of classification in the low resilience subgroup.